Anales de la RANM

282 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 SARS-COV-2 INFECTION IN A PATIENT WITH PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA Pablo Estival An RANM · Año 2020 · número 137 (03) · páginas 281 a 285 or ravulizumab) are gold standard treatments for this disease by inhibiting the formation of the membrane attack complex (MAC) (2). Herein, we will delve into the evolution of a PNH patient under ravulizumab treatment with SARS-CoV2 infection. A 43 year-old-men with diagnosis of PNH in April 2014, presenting acute renal failure with macrohe- maturia and proteinuria. In the laboratory tests, Hemoglobin (Hb) was 9.9g/dL and lactate dehydro- genase (LDH) was 6296U/L. By flow cytometry a decrease in expression of antigens CD16, CD24 and Aerolysin FLAERS in 85% of neutrophils and 87% of monocytes (CD14 and Aerolysin FLAER) was detected. He was reporting asthenia, retrosternal pain, dysphagia, odynophagia, diffuse abdominal pain, erectile disfunction and dark urine. In January 2016, the patient was referred to our Hospital's Hematology Department for evaluation of anti-C5 treatment. The first dose of ravulizumab ( ALXN-1210-PNH-201 clinical trial) was received on January 20th, 2016 with good tolerance and resulted in the disappearance of asthenia and other symptoms. Since the initiation of ravulizumab treatment, the patient has maintained Hb values over 13g/dL, with LDH values always under 600U/L, and experienced only one episode of breakthrough hemolysis, in the context of influenza A infection, with elevated LDH levels up to 1554 U/L, and maintained acceptable values of Hb (11.1g/dL). He returned on April 8, 2020, for regular dosing with ravulizumab. On this day, laboratory measures from the patient showed evidence of breakthrough hemolysis (Table 1). A flow cytometry test was performed (Figure 1). Upon questioning, the patient described mild catarrhal symptoms the previous week. He reported dry cough with no fever nor any other infectious symptoms. The patient presented in good general condition, afebrile, with oxygen satura- tion of 100%. Two units of packed red blood cell concentrates were transfused, and antibiotic treatment with Cefixime and Ciprofloxacin was prescribed, as well as antithrombotic prophylaxis with Enoxaparin. Due to suspected SARS-CoV-2 infection, a nasopharyngeal exudate sample was collected, with a positive test result. The patient remained asymptomatic, without any new symptom of infection or hemolysis. The chest X-ray on April 13, demonstrated clear improve- ment of infiltrates in right inferior lobe without the appearance of new consolidations (Figure 2). The analysis showed a clear decrease in the acute phase reactants, with normal values of C-reactive protein and procalcitonin, without decrease in the hemoglobin levels (Table I). Upon examination on the 27th of April, the patient continued to be asymptomatic. In the chest X-Ray, the infiltrates had disappeared (Figure 2). The hemoglobin levels had increased, approaching normal values. The values of fibrinogen, D-dimer, LDH, and ferritin were within the normal range (table 1). CASE REPORT Figure 1. Flow cytometry. A: Display of CD157 in granulocyte population (GPI+ red cells, GPI- cyan cells) and in monocyte population (GPI+ yellow cells, GPI- blue cells). B: Display of FLAER in granulocyte population (GPI+ red cells, GPI- cyan cells) and in monocyte population (GPI+ yellow cells, GPI- blue cells). C: Display of CD59 in red blood cells (GPI+ orange cells, GPI- gray cells).